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Brian Jenkins

Gazette Opinion: Finding meaning at the end of life

The following letter came to my attention from one of our faithful QLC readers. The author, David Benrimoha, a McGill medical student, (pictured left) argues against the proposed legislation permitting the practice of euthanasia in the province - bill 52. He argues that our ability to form meaning is central to human beings and to deny this is not right. Euthanasia denies this right and an important time of one's life.

I have never experienced what it is like to see a terminally ill family member in pain, and so I do not for one moment pretend to judge or criticize the choices or beliefs of patients or their families. Instead, I want to offer a philosophical argument against euthanasia and in favour of alternative practices, such as expanded access to palliative care.

There is a character in Harper Lee’s classic novel To Kill a Mockingbird called Mrs. Dubose, an old woman who is terminally ill and addicted to the morphine that she takes for her terrible, fitful pain. As a punishment for misbehaving, Jem (the narrator’s brother and the son of lawyer Atticus Finch) is made to read to her every day. At the end of every reading session a bell is rung and Mrs. Dubose receives her dose of morphine. But every day the bell is rung a little later, and in this way, even though she faces the return of her pain, Mrs. Dubose weans herself off the morphine and dies free of the mind-clouding painkillers.

It has taken me a long time, but I now realize why I find this story so powerful. It is because it is an expression of what I consider to be the most human of all desires: the desire to create and hold onto meaning in one’s life. Mrs. Dubose could probably have convinced her servants to give her a lethal dose of morphine — a common practice in assisted suicide — but instead chose a course of suffering that led to her final, though short-lived, victory over her addiction. Outwardly this may seem pointless: Why, if she was going to die anyway, should she have suffered so much?

In my opinion, our society has become preoccupied with pain and suffering and preventing it at all costs. It is of course logical and just to prevent and ease pain and suffering when we can, and to develop and use medications and technologies that can do this. But is death preferable to pain? In a video that was shown to us in class (not directly related to euthanasia) Viktor Frankl — philosopher, neurologist, psychiatrist and Auschwitz survivor — speaks of the extreme suffering he and his fellow inmates were subject to in the concentration camp, and of how, even in the midst of all that suffering, he was able to find meaning in choosing his own attitude to his situation, and in thinking of his love for his wife, who had been sent to another camp. He is far from the only example of a person who, through extreme suffering such as that caused by the Holocaust, has been able to create and find meaning.

In Quebec, euthanasia is being considered for persons suffering from a terminal illness who are still able to make competent decisions. Yet these are the very people who are most likely to be able, with the right support, to find or create meaning at the end of their lives. This is why I am against euthanasia: because allowing it is saying that we are willing to sacrifice our potential to find meaning in order to end suffering; that we have allowed pain to conquer the pursuit that most defines our humanity.

The best counter-argument to all this is that we as a society have no right to demand that people keep on living in terrible pain when they, as competent adults, would prefer a quick death. My response is that this choice is not the one we are faced with. We have, as has been pointed out by many doctors, technologies and medications that can allow us to manage pain; we have psychologists, chaplains and other guides who can help people find and create meaning in their final days. All of this is brought together in the discipline of palliative care, which aims to help patients find the peace and dignity they want at the end of life, on their own terms. These technologies and approaches are not perfect, of course; they cannot prevent all suffering. But I have seen them work, seen that despite their suffering patients continue to love, to reconcile with estranged family members, to play music, to eat favourite foods, to reflect, and to find meaning in life.

As a society we should be putting our efforts into improving end-of-life care. Palliative care in situations where an illness cannot be cured has proven to be less resource-intensive compared to aggressive treatment, or repeated stays in an intensive-care unit — both of which entail expensive medications and procedures, and the time of large numbers of specialized staff. As such, palliative care is a sustainable option, a responsible use of our health-care resources that ensures patients are able to die with dignity. Even though the process may be painful and draining for patients, families, doctors, nurses and other health professionals, I believe that the beauty and power of the human experience of creating, finding and holding onto meaning is worth it.

David Benrimoh is a first-year medical student at McGill University. He lives in Côte-St-Luc.